Department of Occupational Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Kaohsiung J Med Sci. 2011 Dec;27(12):554-9. doi: 10.1016/j.kjms.2011.06.029. Epub 2011 Nov 25.
The purpose of this study was to investigate the potential risk factors for the reactivation of the replication of hepatitis B virus (HBV) and hepatitis C virus (HCV) after transcatheter arterial chemoembolization (TACE) of hepatocellular carcinoma. Forty-four hepatocellular carcinoma patients treated by TACE using epirubicin plus mitomycin C were studied. Serum HBV DNA (n=17) and HCV RNA (n=27) levels were measured 1 day before and 3 months after TACE. Plasma concentrations of chemotherapeutic agents were determined at 1 hour and 72 hours after TACE. A total of 29 patients (n=13 for chronic hepatitis Band n=16 for chronic hepatitis C) showed significant changes of the viral loads after TACE. Patients with increased viral loads after TACE were older (p=0.041), had higher incidence of pre-TACE white blood cell counts being less than normal limit (p=0.023), and had higher plasma mitomycin C concentrations (p=0.039) than those in patients with decreased viral loads. Analysis by multiple logistic regressions using age, decreased or normal pre-TACE white blood cell counts, mitomycin C concentrations >3.95 ng/mL adopted by receiver operating characteristic curve (p=0.037), and epirubicin concentrations have shown that decreased pre-TACE white blood cell counts was the only significant factor associated with increased viral loads after TACE (p=0.048). In conclusion, patients with decreased pre-TACE white blood cell counts have a potential risk for the reactivation of the replication of HBV or HCV after TACE.
本研究旨在探讨经导管动脉化疗栓塞（TACE）治疗肝细胞癌后乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV）复制再激活的潜在危险因素。研究了 44 例接受表柔比星联合丝裂霉素 C 行 TACE 治疗的肝细胞癌患者。在 TACE 前 1 天和 3 个月检测血清 HBV DNA（n=17）和 HCV RNA（n=27）水平。在 TACE 后 1 小时和 72 小时测定化疗药物的血浆浓度。共有 29 例患者（n=13 例慢性乙型肝炎，n=16 例慢性丙型肝炎）的病毒载量在 TACE 后发生明显变化。TACE 后病毒载量增加的患者年龄较大（p=0.041），TACE 前白细胞计数低于正常值的发生率较高（p=0.023），且血浆丝裂霉素 C 浓度较高（p=0.039）。采用多因素逻辑回归分析，采用年龄、TACE 前白细胞计数减少或正常、采用受试者工作特征曲线（p=0.037）的 3.95ng/ml 以上丝裂霉素 C 浓度和表柔比星浓度，表明 TACE 前白细胞计数减少是与 TACE 后病毒载量增加相关的唯一显著因素（p=0.048）。总之，TACE 前白细胞计数减少的患者存在 HBV 或 HCV 复制再激活的潜在风险。
